Developing a Resident Assistance Program Beyond the Support Group Model

Background: A program designed to identify and address specific evolving needs of residents throughout their first year has been implemented in our department of medicine. The average annual participation is 55 residents. The program includes a detailed and structured curriculum with topics and activities aimed at improving nonclinical skills that help residents function effectively during residency. Methods: The program was developed based on a careful analysis of problems reported by graduating residents. It consists of 12 sessions in which the residents are presented with typical difficult situations they are likely to encounter during the year. At the end of each session they are provided with strategies to help them deal with the problems or even prevent problems in some cases. An important aspect of the program is the training and utilization of senior residents as group leaders. Results: Eighty-five percent of the first-year residents have actively participated in the program since July 1989 despite its voluntary nature. Participants reported that the program greatly accelerated their adaptation and helped them function more effectively in the system. Senior residents recognized benefits for their professional development as well. Conclusions: The collective wisdom of past generations is often not effectively communicated to postgraduate year 1 residents. They are left to reinvent the wheel, not always with the best results. As a consequence, a great deal of stress that can be minimized is introduced into the training process. This program shows promise as an effective mechanism to deal with these challenges. (Arch Intern Med. 1993;153:729-733)